CIHM 
Microfiche 
Series 
(Monographs) 


ICMH 

Collection  de 
microfiches 
(monographies) 


Canadian  Institute  for  Historical  Microreproductions  /  Institut  canadien  de  microroproductions  historiques 


I 


Technical  and  -..oiiographic  Notes  /  Notes  techniques  et  bibliographiques 


The  I--  tituie  has  attemr:n  '  ■;.  obidvi  the  be<^(  original 
copy  available  for  filmin-,  F?iturcs  of  this  copy  which 
may  be  bibliographically  un.^u-3  w'^u-h  may  alter  any  of 
the  images  in  the  reproductioti,  or  which  may 
significantly  change  the  usual  method  of  filming  are 
checked  below. 


n 


Coloured  covers  / 
Couverture  de  couleur 


I      I    Covers  damaged  / 


Couverture  endommagee 


I       I  Covers  restored  and/or  laminated  / 

I 1  Couverture  restauree  et/ou  pelliculee 

I j  Cover  title  missing  /  Le  titre  de  couverture  manque 

' I  Coloured  maps  /  Cartes  geographiques  en  couleur 

I      j  Coloured  ink  (i.e.  other  than  blue  or  black)  / 


Encre  de  couleur  (i.e.  autre  que  bleue  ou  noire) 

Coloured  plates  and/or  illustrations  / 
Planches  ot/ou  illustrations  en  couleur 


Bound  with  c'her  material  / 
i 1    Relie  avec  d'autres  documents 


D 


D 


n 


Only  edition  available  / 
Seule  edition  disponible 

Tight  binding  may  cause  shadows  or  distortion  along 
interior  margin  /  La  reliure  serree  peut  causer  de 
I'ombre  ou  de  la  distorsion  le  long  de  la  marge 
interieure. 

Blank  leaves  added  during  restorations  may  appear 
within  the  text.  Whenever  possible,  these  have  been 
omitted  from  filming  /  II  se  peut  que  certames  pages 
blanches  ajoutees  lors  d'une  restauration 
apparaissent  dans  le  texte,  mais,  lorsque  ceia  e!ait 
possible,  ces  pages  n'ont  pas  ete  filmees. 

Additional  comments  / 
Commentaires  supplementaires: 


L'Institut  a  microfilme  le  meilleur  exemplaire  qu'il  lui  a 
ete  possible  de  se  procurer.  Les  details  de  cet  exem- 
plaire qui  sont  peut-etre  uniques  du  point  de  vue  bibli- 
ographique,  qui  peuvent  modifier  une  image  reproduite, 
ou  qui  peuvent  exiger  une  modification  dans  la  nietho- 
de  normale  de  filmage  sont  indiques  ci-dessous. 


^1    Coloured  pages  /  Pages  de  couleur 

I I    Pages  damaged/ Pages  endommagees 

I      I    Pages  restored  and/or  laminated  / 


□ 

□ 

□ 


Pages  restaurees  et/ou  pelliculees 

Pages  discoloured,  stained  or  foxed  / 
Pages  decolorees,  tachetees  ou  piquees 

Pages  detached  /  Pages  detachees 

Showthrough  /  Transparence 

Quality  of  print  varies  / 
Qualite  inegale  de  I'impression 

Includes  supplementary  material  / 
Comprend  du  matenel  suppiementaire 

Pages  wholly  or  partially  obscured  by  errata  slips, 
tissues,  etc.,  have  been  refilmed  to  ensure  the  best 
possible  image  /  Les  pages  totalement  ou 
partiellement  obscurcies  par  un  feuillet  d'errata.  une 
pelure.  etc.,  ont  ete  filmees  a  nouveau  de  fafon  a 
obtenir  la  meilleure  image  possible. 

Opposing  pages  with  varying  colouration  or 
discolourations  are  filmed  twice  to  ensure  the  best 
possible  image  /  Les  pages  s'opposant  ayant  des 
colorations  variables  ou  des  decolorations  sont 
filmees  deux  fois  afin  d'obtemr  la  meilleure  image 
possible. 


This  Item  is  dlmed  at  the  reduction  ratio  checked  below  / 

■_c  i:^z-^—.z",  ci;  7[liVi£-  ou  ;  iu«  cie  n-u'jtiioii  indique  ci-dessous. 


10x 


14x 


18x 


12x 


16x 


20x 


22x 


26x 


30k 


24x 


28x 


32x 


Thfl  copy  filmed  here  has  been  reproduced  thanks 
to  the  generosity  of: 

J.J.    Talman  Regional    Collection, 
D.B.   Weldon   Library, 
University  of  Western  Ontario 

The  images  appearing  here  are  the  best  quality 
possible  considering  the  condition  and  legibility 
of  the  original  copy  and  in  keeping  with  the 
filming  contract  specifications. 


Original  copies  in  printed  paper  covers  are  filmed 
beginning  with  the  front  cover  and  ending  on 
the  last  page  with  a  printed  or  illustrated  impres- 
sion, or  the  back  cover  when  appropriate.  All 
other  original  copies  are  filmed  beginning  on  the 
first  page  with  a  printe<^  or  illustrated  impres- 
sion, and  ending  on  the  last  page  with  a  printed 
or  illustrated  impression. 


The  last  recorded  frame  on  each  microfiche 
shall  contain  the  symbol  — <^  (meaning  "CON- 
TINUED"), or  the  symbol  V  (meaning  "END"). 
whichever  applies. 


L'exemplaire  filmd  fut  reproduit  grace  i  la 
g6n^rosit6  de: 

J.J.    Talman  Regional    Collection, 
D.B.    Weldon  Library, 
University  of  Western  Ontario 

Les  images  suivantes  ont  6xi  reproduites  avec  le 
plus  grand  soin.  compte  tenu  de  la  condition  et 
de  la  nertet*  de  l'exemplaire  film*,  et  en 
conformit*  avec  les  conditions  du  central  de 
filmage. 

Les  exemplaires  originaux  dont  la  couverture  en 
papier  est  imprim^e  sont  fi'-i^s  on  commencant 
par  le  premier  plat  et  en  t  ■     linant  soit  par  la 
derniAre  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration,  soit  par  le  second 
plat,  selon  le  cas.  Tous  les  autres  exemplaires 
originaux  sont  film*s  en  commenpani  par  la 
premiere  page  qui  comporte  une  empreinte 
d'impression  ou  d'illustration  et  en  terminant  par 
la  derniire  page  qui  comporte  une  telle 
ampreinta. 

Un  das  symboles  suivants  apparaitra  sur  la 
derniAre  image  de  chaque  microfiche,  selon  le 
cas:  le  symbo'e  — ^  signifie  "A  SUIVRE ".  le 
symbole  V  signifie  "FIN". 


Maps,  plates,  charts,  etc..  may  be  filmed  at 
different  reduction  ratios.  Those  too  large  to  be 
entirely  included  in  one  exposure  are  filmed 
beginning  in  the  upper  left  hand  corner,  left  to 
right  and  top  to  bottom,  as  many  frames  as 
required.  The  following  diat^rams  illustrate  the 
method: 


Les  cartes,  planches,  tableaux,  etc..  peuveni  etre 
film*s  i  des  taux  de  reduction  diff^rents. 
Lorsque  le  document  est  trop  grand  pour  etre 
reproduit  en  un  seul  cliche,  il  est  film*  d  partir 
de  Tangle  sup*rieur  gauche,  de  gauche  i  droite. 
et  de  haut  en  bas,  en  prenant  le  nombre 
d'images  i^cessaire.  Les  diagrammes  suivants 
illustrent  la  mAthode. 


1 

2 

3 

1 

2 

r 

3 

4 

5 

6 

MK 

:rocopy  resolution  test 

ANSI  and  ISO  TEST  CHART  N 

1.0    !!ia 

CHART 

■    2 

... 

20 

I.I 

1.8 

1.25 

1.4 

1.6 

^  ^p 

=1 

-lED  IIVM 

GE       Inc 

-=r- 

"-^= 

The  Effect  of  Temporary  Occlusion 

of  Renal  Circulation  on 

Renal  Function 


I-.   (, 


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i:  M.I  I  MOL'I, 


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AMimCAX    Mi  UHAl.  .\.S^SI.CIlllo^ 

'■'"  '       lll^r,|,ll.      IM.      rufllH     |-|M       \,,|,1H      |i|\l|M.l|iS 


The  Effect  of  Temporary  Occlusion 

of  Renal  Circulation  on 

Renal  Function 


i;.     FITZ.     M.Ji,.     AND     1.^     I,      i;  (I  W  N  T  i;  i;  K.     M 

ISALllMOIiL 


THE  i:ffi:(  T  of  tkmi(»i;ai;v  (x  (Lrsiov  of  hexal 

CIl.'crLATloX    (IX     i.'KNAI,    FrX(-|-l(  iN  -^ 
n.    FIT/:.    M.n.    am,    i..    i,-.    i;(i\\\ti;i:i:.    m  d. 

DAI  I  l\!n'!|: 


Of  fjiviit  iiii|in|'tainc  111  ivlaiii.n  I>,  \\u-  .-iii-ny  nf  ili,.  ki.lnrv  is  t!i.. 
question  rniHcniii:-  III,.  1,.,1-th  ..f  tini,.  thm  i|„.'  ,vikiI  v,.->,.1> 'may  he 
claniiHM!  u-itli,.u!  ii.^i-iiiiiiicnt  injiirv  in  ivnal  t'lm.  ti,,n  .,r  iviial  ii>Mir.  'I'li.. 
qur.-tidii   is  ilrall  Willi  li,.iv  (■\iiriaiiiciitally.     Tlw  iviial  \.-m.1s  in  ral.iiil- 

and   do-s   !ia\.'   1 n   daniiKMl    Im-   xai'vin-   j.rnn.K   ,,|'   im,,,,.   ;„„]    s,,!,,,.. 

(|Mfntly  ivnal  fiin.-li,.n  ha-  linai  U:\rA  Kv  th,.  r\civii,,ii  ,,f  i,|i,.n,,lMil- 
I'lmnrnlitlialcin.  Ian,,-,..  i„,ia-iiii,i  i,„li,l.  salt  iiii,l  u-at,T.  Tli,.  |.n-,.|:,v 
or  ab.-eiuv  i<(  albmiiin  aii,l  ,a-N  in  tin-  uriiir  lias  lnvn  (,lis,.r\v,l.  Tli,. 
results  ,,r  .-,i,-||  fiii;,ai,,n,.,l  stii,!i,.s  luwr  li,.,ai  . uniivll,.,!  l,v  lii-l(,|,,..'i,-al 
cxaniiniiti.iii  !,1  tin-  ki,lni'\^. 

''''"'  ''"'■'■'  "''  "l-tniiai,,n  t.i  th,.  naial  ciivulath.n  (,ii  lii,,  unnarv 
I''"'""''-  •""'  '!"■  iii>i"l-i:y  ..r  th,.  Li, ill, .y  has  alwady  l„rn  invest i-ittM. 
f{nliin-,.n'  .-h,,uv,l  ihat  i\iii-,,|  ili,,  ivnal  v.^iu  ivMilt.',!  in  th,.  npiH'ariKuv 

"''   •il''-iiiiii.    I.I I.  ,,r   l„,tl,.    in    111,.   „,.j,„,.   ,|,„i    ,„   ,.„|.,,.^r,,;,„.|,,    ,,.■   ,i„, 

ki,ln..y.  This  ha-  h,.,.n  <  ,,iilii-ni,.,l  by  ,,tli,.r  (.hs,.n,.is.  l'an,.th.-  Miink' 
ii!i,l  ,1,.  S,nv/:i'  lia\,.  >li,,vvn  that  l',,ll,,vvin.^  lipiti,ai  ,,!'  th,'  ivnal  vian.  tlio 
iiiinr  i.-  Miiall  in  ani,,iiiit.  Linlv.iu-'  Inun,!  that  c  laiiiiiini:  the  ivnal  v,-,-|> 
*^"''  "  !'"■'■''"'  "'■  "linut,-  fivqiHaillv  iiit..|lV'r,.,t  with  tiu'  .-,.,-n.ti.,ii  ,,i  in  in,' 
I''"'  li"i''.~-  llci'l.aihain''  Iniiiul  that  ,,n  fivuin,::  tlu-  ws^ds  al'tiT  a  t,.ni- 
pnraiy  <  lai.ipin-  the  s..,ivti,,ii  ,.r  iirin,.  iii,|  not  l,..i,'in  at  oniv.  Littuii" 
(|li.-onv,l  an,.r  olaiiiiun-  lH,th  ivnal  m.>.-,.|s  r,,r  i,eri,„ls  up  to  two  hours, 
that  th.'  knin,.y  lH.,.aiii..  ,.nlai-,.,l  ai,,i  .■,,n-,.si,.,|.  If  th.'  iviial  artery 
■''"'"■  "■■'-  'i"'l  '■"!■  o!i,'-!i,alr  or  ..ii,.  h,,iir.  alhiimin  an,l  oasis  ap|i,.ar,.,i  ili 
the   nnn,..      I'atli.,l,i-i,,ill\.  th,.   lulnil,..-  w,.:v  alloc-i,.,!  as  sh.iwn   hy  tlu'ir 

*  .'^iii.iiiUi,.,!  for  piililh.atii.ii  Mai,.!,  2ii.   I'ai:!. 

*  iMviii  till-  M-.,li,.al  iTinio.  ol   tli,.  I'.t,!-  INnt   Ilri-liani  U,)-!,ilal,   l;,,.t'>n    .in,! 
til,.   l'lKiMiia,.„l„i;iral   ;.alM,vaI,,iy  ..f  tl„.  .l„l„i-   llepkins   l„iA,.rsit\ .  I!altiin„i,..' 

•  l,r  n.vi..u-  „t   lit,-intnr,.  ,-,,ii,.,.rniii-  [..mijl  ,„•  ,.,.iii|,|,.t,.  ..j.-tniotioii  t,,  i,.ii;il 
circiilala.n    s,..'   our    pi.-vi,.!,-    |,;,|„.r.      |;, ,»„,,.,■,■.    V\u   an. I    (l..ra-litv:     Stii,|i,.<  „i^ 
Ki'iial   l'iin,ti,>ii  in  K\|„.riiii,.,ital  (  lirnni,.  l>;,-iv,.  I  ,,ii._M.-ti,ai     liii    '\ii,iims   Im 
.Mm..    I!il;i.  \\.   lit. 

1.  l!,,|,ins,iii :     Mi.,|.   (  |iir.    I'r..    is^ii     v  >.v  i     .-,!, 

■_'.  I'anctli:      I'IIuliit'-  .Xrch..   iss,;.  w^K.  .-)!.-). 

:i.  .Miiiik:     lli'il.  klin.  W,lin-ilir..   Isiit.  j,  ;i.-i:i. 

I.  !)•'  .'si,ii/i  :    .l.air.   ,'liy-i,,|..   llloil.  w.i.   i;!!i. 

.").  l.l|i|Hi;r    I'llVsiolii;;!,.,    1  s.",,;.    jj      ||ii 

•  i.  !l.'i,|,.iilKiia:     I|,.niianir^   llaii.ll,.  .1.   I'li\-i.,l  .    1<S3.  v.    li'l!    1.  :!l'1 
7.  laln.ii:    /t-..|ir.  f.  Klin,   .M,-,l..    Issii.  |,,    ml. 


inability  to  fiaiu  with  iiiili;;o  rannir..  Fiut  .-tuh  cliangcs  were  temporary. 
If  the  artery  was  clanijici!  for  two  hours,  permanent  injury  oecurreil, 
eviilencttl  by  tubular  necroji;  with  cast  production,  cellular  infiltration, 
rcjulling  in  circumscribed  scar  formation  with  calcification. 

Chirie  and  ^Mayer'  after  temporary  clanipini:;  of  both  renal  veins  in 
do_'i,  Tioted,  in  four  out  of  seven  cases,  death  with  convulsions.  CarreP 
was  unable  to  confirm  this  observation. 

Eisendrath  and  Strauss'"  have  studied  the  pathological  changes  in 
the  kidneys  of  rabbits  after  coinprc.-sing  the  renal  vessels  for  from  fifteen 
to  ninety  minutes.  According  to  their  rc.-ults,  temporary  compression  — 
I'.alf  an  hour  or  h -s  —  (aused  slight  damage.  If  longer,  marked  pe'-- 
ii'.anent  lesions  occurred  in  the  parenchyma,  as  cxidenced  by  interstitial 
cellular  infiltration,  coagulation  necrosis  of  tubular  ejuthelium,  and  Inter 
by  tl'.e  depositio!!   of  calcium  in  and  about  the  destroyed   epithelium. 

Tluis  it  has  been  slunvn  that  daitiping  of  thi>  renal  vessels  for  periods 
up  to  an  hour  may  produce  temjiorary  anuria,  albuminuria  and  cylin- 
druria.  If  interference  with  the  renal  circulation  is  maintained  suffi- 
cientlv  long,  permanent  interstitial  increase  in  tissue  occurs  in  the  kidney. 
Except  for  the  amount  of  urine  excreted  and  the  presence  in  it  of  albumin 
or  casts,  no  systematic  sttidy  of  renal  function  under  such  conditions 
has  been  made. 

.\lTIirii;s'  rxi'F.nniKNTS 

In  our  e\perimeiits  ralihit>  ar.d  dogs  were  ethrri;!ed  and  the  abdomen 
opened  nscptically  in  the  niciian  line.  'l"he  Icfr  kidney  was  exposed,  and 
by  careful  blunt  dissection  the  vessels  were  freed  from  the  surroundinc; 
tissues.  The  arterv  and  vein  were  raised  on  an  artery  forceps  with  as 
little  stretcliing  as  possible  and  a  small  rubber  protected  bull-dog  clamp 
placed  around  them.  In  each  experiment  it  w'as  noted  that  on  the  distal 
side  of  the  forceps  the  artery  did  not  pulsate,  while  the  vein  at  once 
became  distended:  on  the  ]>roxinial  side  the  vein  was  collapsed  and  the 
artery  pulsated  normally.  Xo  attempt  was  n;ade  to  prevent  the  capsular 
circulation.  After  the  left  renal  vessels  were  clamped,  the  right  renal 
vessels  were  licated.  The  riglit  kidney  was  lemoved  and  weighed.  In  a 
few  animals,  i(ir  eontrcl.  the  right  kiilncy  was  left  untouched. 

While  tlie  i  lamp  ua-  in  ]']aie,  the  abdnnicn  was  closed  and  covered 
with  a  warm  .siiiiic  pad  and  towel.  To  try  to  obviate  the  factor  of 
sliock,  the  body  heat  was  maintained.  The  animals  were  anesthetizeil  as 
lightly  as  jiossible.  After  the  desired  interval  of  time  had  elapsed,  the 
clamp  was  removed,  the  niacro^coidc  appearance  of  tiie  kidney  noted,  an  1 


s.  (  liiric  and  .Mayer:    (  onuit.  rcml.  Soc.  de  liiol..  I!tn7.  i.  50S. 
;'.  (  arrtl:    C  onijit.  roinl.  d.  Sec.  do  Mol..  I'.lfill.  i,  527. 

10.  Eisendrath   and   .'^trau^s:    ,Tour.   Am.   Med.   .\»sn.,   \'Mi}.  Iv,  22SG;   see  also 
Guthrie:    The  Archives  Int.  Med.,  I'JIO,  v,  232. 


/ 


the  i)oritoneum  and  alxluinuii  seu  n  up.     The  i)hidili-r  iva.;  th.  ,i,io'i 

and  the  animals  placed  in  molaholism  l.u.  -.  The  ehiinp  wa-  applied  in 
!-eries  of  animals  for  ten,  twenty,  thirty,  forty  and  sixty  .ninutes. 
I'epoated  studies  of  lenal  function  were  made.  Finally,  the  animals 
were  killed,  suhmitted  to  autopsy  and  the  kidneys  examined  histohiirically 
after  formaldehyd  iixatioii,  celloidin  imbedding  and  h'-'iiatoxvlin  and 
cosin  staining. 

XrCHN-IC  OF  THSTS  OF  IlKXAL  FLXCTION- 

A  short  (leseriptioii  of  the  \a;iou>  te>t-  used  for  renal  function,  with 
tiu'ir  technic,  is  given. 

Tlie  plitlialein  test  wn-  tiia.lc  arfDriliiii.'  to  tlio  oriiiinal  (oclinic  of  nowntiiv 
and  Geraulitr."  One  cubic  contiiiipti-r  of  a  ]ilienolsiil]iIion(>plitlialein  solution  con- 
tainin;;  accurately  C  niilliirann  was  injectoii  nseptically  into  tlio  Iclt  nui-'cle-'  of 
the  rabbits  or  lumbar  muscles  of  the  dogs,  wliicli  were  tlion  iilace.l  in  metabolism 
ca;.'es.  The  bladders  were  oxpresscci  or  catheteri?ed  at  the  end  of  an  hour  ami 
ten  minutes,  and  the  total  urine  for  this  time  colloetcd.  The  urine  was  made 
distinctly  a'kaline.  diluted  (o  1  liter,  and  the  amount  of  druf;  determined  by 
the  use  of  Rowntree  ami  Geraghty's"  modification  of  the  .Autenrietb  Ktlniis- 
berger  colorimeter.  In  control  animals  it  has  been  determined  that  tli"  normal 
output  in  this  time  is  00  per  cent,  or  njore. 

The  lactose,  potassium  iodid.  salt  and  water  tests  which  have  received  a 
tliorough  study  at  tlie  hands  of  Schlayer"  and  his  en  workers  and  which  we  have 
used  in  relation  to  the  renal  function  in  experimental  and  clinical  nepliritides. 
were  applied  to  this  study. 

From  our  previous  work  we  feel  that  the  nuchanism  of  tlio  excretion  of 
lactose  differs  essentially  from  that  ot  phthalein.  salt  and  iodid.  ThrouL'hout 
this  investigation  W!  have  used  it  as  an  index  of  the  condition  of  tlie  va-cular 
function'*  of  the  kidney,  admitting  tliat  we  need  much  more  information  concern- 
ing the  manner  and  significance  of  its  excretion. 

Tile  teclinic  tor  the  lactose  test  in  rabbits  lias  been  identical  with  .'^clilayer's. 
tine  gram  of  lactose  dissolved  in  10  c.c.  of  distilled  water  was  injected  into  the 
ear  vein.  The  animals  were  placed  in  metabolism  cages,  the  bludiler  expressed 
at  the  end  of  four  hours  and  every  hour  thereafter  up  to  eight  hours.  In  dogs, 
according  to  our  previous  technic.  2  gm.  were  disso'i.i-d  in  -20  c.c.  of  water,  ami 
injected  into  the  lumbar  muscles. 

i^ince  the  time  necessary  for  total  elimination  lias  hevn  considered  bv  Schlaver 
of  greater  importance  than  the  absolute  amount  recovered,  and  since  our  pre- 
vious ob.servations  with  lactose  excretion  agree  with  this,  we  have  observed 
this  exclusively.  The  presence  of  lactose  in  the  urine  was  determined  by 
Nylander's  test,  using  similar  amounts  of  urine,  reagent  and  length  of  boiliiiLr 
time. 

In  rabbits  under  these  conditions,  the  time  necessary  for  the  complete  elimin- 
ation of  lactose  is  normally  six  hours  or  less  and  in  dogs  from  four  to  six  Iiours. 


11,   liowntrce  and  Oeraghty:    ,Iour,  Pilar,  and  Exper,  Tlierap.,  1910.  i,  5T1>. 
1-'.  Huwntree  and  Geraghty:    The  .Archivks  Int.  .Ued.,  1912,  ix,  284, 

13,  Schlayer:  Deutsch,  Arch,  f,  klin,  Med,,  1911.  cii.  311:  Schlayer  and 
Takayasu:     Deutsch,  Arch,  f,  klin.  Med.,  1S91,  xcviii.  17;   1910,  ci,  333. 

14,  For  a  review  of  the  literature  on  this  test  and  the  others  described  below, 
see  our  jircvious  paper.  We  have  shown  in  a  previous  publication,  liowever,  that 
lactose  is  not  excreted  solelv  bv  the  glomeruli. 


• 


Arcordic!:  to  tlic  ftmlif<  cf  Srlihiyer.  iHtn-.-iuin  iiulul  is  excreted  by 
the  tubules  of  tiie  kidney,  nvA  on  it  he  has  phued  most  dependenee  in 
determining  tubular  furctioiial  eapatity.  In  these  studies  1  c.c.  of  a 
2.0  per  cent,  sulution  l'.a>  bieli  admini.-tered  intravenously  to  rabbits. 
For  ihi.-  the  noiiiia!  tlliiili.atiiui  time  i:-  twciity-four  hours.  In  dojs, 
(1..J  LMU.  has  bee'i  administered  by  mouth,  which  normally  is  excreted 
witliiii  sixty  hours.  The  presence  of  the  drug  in  the  urine  has  b-en 
determined  by  SandowV'''  test. 

The  excretion  of  salt  following  it-  administration  in  amounts  greatly 
in  excess  of  that  ordinarily  taken  with  the  food  is  aecomidi.-lnd  by  the 
tubule^.  according  to  Sehlayer.  Normally,  a  laruo  amount  of  salt  i- 
excreted  by  one  of  two  methods.  If  it  i^  -ivcu  wiihont  extra  wati-r.  it 
i--  almost  entirely  excreted  within  twciiiy-l'air  hours  without  diuresis  by 
increased  salt  concentiaiion  in  the  urine;  if  given  with  an  excess  of  water, 
it  is  excreted  T>artia!ly  ihiougli  increased  eoiH-entration  in  the  urine  and 
partially  tlirougli  diuresis. 

Where  vas(  ular  injury  to  tlie  kidney  exists,  the  simple  administration 
of  salt  may  bo  followed  by  a  marked  diuresis,  all  of  the  salt  being 
excreted  in  twenty-four  hours  without  its  percentage  content  in  tiie  urine 
beins  at  all  increased.  This  is  usually  associated  v., to  a  somewhat  low 
and  fixed  specific  gravity  and  the  syndrome  is  spoken  of  as  "vas,  :-lar 
hypothcnuria."'  Here  the  inability  to  concentrate  is  not  du"  to  any 
incapacity  of  the  tubules  to  exc.-ete  salt,  but  to  '  •  crseiisitive  ves^els 
which  respond  to  the  salt  administration  with  a  diurcM-.  In  mnii'  severe 
vascular  injiiiv  ilie  vessels  do  not  act  in  the  sa way.  oliguria  charac- 
terizing the  urinary  picture.  In  severe  tubuhir  de-triu  ti^ii.  a  urine  of 
fixed  low  spccitic  gravity  is  obtained,  the  quant iiy  «i  which  is  imt 
materially  affected  by  the  administration  <.f  extra  amoimi>  of  salt,  and 
the  salt  content  of  which  is  not  augmented  by  administratinn  nf  I'xtra 
amounts  of  silt  because  of  the  inability  of  the  tnbuli  >  to  excrct.'  il.  Sik  h 
a  condition  is  known  a-  ■•tubular  hyiHoilienui  m" 

In  these  studies  gin.  l.o'>  were  given  by  stomach-tube  to  the  ralibits. 
and  gni.  3  to  dogs.  Tiie  urine  for  the  foUowini;  twenty-four  Imiirs  wa>^ 
collecte<l,  and  the  salt  concentration  aiid  ab-cluic  (  \Melion  e^tiinali'd 
by  the  Liitke-Mart ills'"  method. 

Finally,  in  order  to  make  condilions  as  coU'^tant  as  possible,  the 
labbits  were  given  IdO  n,c.  of  water  daily  by  stomach-tube.     In  additinn. 


15.  Sandow's  iiutliod  cnnisis't*  In  aiMint'  1  o.c.  of  ■:  per  i.'tif.  Mi<liuiii  nitrite 
►o.iition  anil  1  c.c.  of  10  [icr  wnt.  ll^Sd,  t.i  fidni  10  to  30  c.c  of  urine,  fullnwr.l 
l>v  tic  ndilition  of  n  sni.ill  iininnnt  of  chloroform.  TMii  i«  slialicn  teecthcr  and 
nllowcd  to  scparnte  into  ln,\(f.  tl.  ■  I'nscncc  of  tlic  jodid  Uw^  indicated  liv  a 
|nir|di«li  red  or  violet  c(dor  in  llie  cliloroforni. 

US.  Sahli!    Lrlirlmch  der  klini-cl;. n  >i!it.'r-ii(hiMie>'.  Metlioilui,  Iran/  Dcnticke, 
LoipTig  nn.l  Wien.  JSUii,  p.  421. 


they  were  allowcil  to  cat  giccn  vcj:ctablo.-  ad  libituni.  This  produced  a 
constant  polyuria.  Hence  the  anioinits  of  nrine  were  not  followed  from 
day  to  day.  Th.e  duff?  were  allowed  MOii  c.c.  of  water  daily,  and  were  fed 
on  meat  when  able  to  retain  liquid  or  Milid  food.  The  lactose,  ph'ihalein 
and  iodid  tests  were  given  synchronotisly  since  their  excretion,  and  quan- 
titative dctenuiiiation  do  not  interfere  with  each  other.  In  dogs.  lactose 
and  jijitlialein  were  i:i\en  at  the  same  lime,  but  into  tlic  muscles  of 
opposite  sides. 

Single  catheter  nr  expre-scil  fpieimciis  of  mine  were  taken  from  day 
to  day.  Albumin  was  tested  i)y  the  nitric  aeid  method.  The  sediment 
of  centrifuged  urine  was  examined  niicrosiopically  for  blood  or  casts. 

As  previously,  in  these  studies  we  have  cdiisidercd  the  excretion  of 
lactose  as  an  index  of  va^-eular  functional  (apacity:  that  of  phthalein  as 
nil  index  of  total  renal  fuiiction  (though  predominantly  tubular),  and 
the  excretien  nf  -alt  and  iedid  as  an  index  of  tubtdar  functional  capacity. 

The  results  of  thc-e  >tudie-  are  slmwn  in  the  accompanying  protocols." 

I'lJiiloriil.s   (iF    I'M'IClAtrNTS 

I.  Animnl*  with  niio  kiilmy  ri'iiiuM  !.  renal  cirruliition  olanipod  for  in  niinnto=. 

I;aiii:it  1. — I!o<ly  wiifrlit  l.fi.jll  siii.  \\i'i;.'Iit  of  removed  kiiiney  4. 'J  gni. 
WfiLrht  of  reiiiaininir  kiiliifv  at  dratli  li..")  mii. 

Siilphonephthali  in  excretion  pooonil    ilay  after  eporatinn  .ST  jier  cent, 

Siilplionei'litlialein  excretion  tliird       day  after  ojieratinn  ti'2  per  cent. 

Snlplionephthalein  excretion  tiftli        day  aftir  <'perotitin  ."iS  per  cent. 

Swlplioncphtlialein  excretion  i^evintli  day  after  operation  5S  ]'er  cent. 

Lactose  excretion   first       day  after  ojieration   (!-T  liours. 

l.actMse  excretion  fonrtli  diiy  after  operation  t>-7  iioiirs. 

Iodic!  excretion  fir-t       day  after  oiieiation  .Tit  lioiirs  +. 

lodiii  excretion  liftli      day  after  operation  ;!tl  lionrs  -f . 

Salt  excretion  third     day  after  operation   1. 00  per  cent.   (1.20  nm.) 

Salt  excretion     sixth  day  after  operation  I.^IU  per  cent.   (1.(10  f:ni.l 

.\!!inniin  jiresent  f"r  fonr  da\s.     K: 
day,     Aniiiial  killed  on  the  ei;;litli  da.\. 


-lit    01 


valine  cast-  found   nnlil   the  >eventli 
1    Lidia-/    4.ii   em.      W.'iL/ht 


II.MIIIIT  :?. — Wei-ht    l,::.'i(l    em.      \\  1 
of  remaining  kidney  at  d>alli  ■)..")  jjni. 

Siilphonephtlialein  excretion  si'Coni!    day  after  operation  tl.'j  per  cent. 
Sniphnneplithalein  excretion  fourth    day  after  operation  !'■.")  per  cent. 
Sulphoneplitlialein  excretion  tifth        day  after  (operation  li'J  per  cent. 
Siilplioneplillialein  excretion  seventh  day  after  operation  tiu  per  cent. 
Lactose-  excretion  tir-t        day  after  oi'eration  II       hours. 
l-actose  excretion  fourth    day  alter  operation  7'j  luuirs. 
Lactose  excntion  seventh  day  after  oiier.ation  ."i       liours. 
loilid  excretion  lirst  day  after  operation  ^fl  hours, 
lodiil  excretiou   toiirth     day  after  operation  '-M  hours, 
lodiil  excretion   -I'Veiilh  ilay  .ifler  (iperatioii   l!il  hours. 


17.  Ill  adilition  -iven  rahliits  wire  useil.  one  with  circulation  cinnipcil  for 
tin  nniiiilis.  tiiiee  for  tliirty  minutes,  and  two  fur  forty  niinutes.  All  died 
within  sixteen  hours  of  operation.  l!eali/iii;r  llie  individual  variation  in  -uscepti- 
hility  and  vita'ity  of  rabl)it!«.  it  seemed  fair  to  exclude  these  animals  from  their 
ajiiiropriati'   taMi-.   especially   as  all   had   hien   deeply   nne-tlieti/ed.   nil   hut    ono 

had   made   p etiier   recoveries,  and   one    ri'Mdt  at   0[)ertttion    had   KUlTereil   fioni 

a  severi'  In  mini  ieiL'e  I'.^v  to  trann  a  if  the  liver. 


f     i      • 


8 


t 


cent, 
o-nt. 
com. 


Suit  oxcrotiim  tliiiil  d.iy  after  oporatinn  1.2.'i  ]ii'r  cent.  ll.HO  am.) 
tSalt  iwcrctiun  si.xth  day  after  operation  1.3  per  cent.   (1.3     gni.) 
Alliiimin  present  for  six  day-;.     Sediment  neiiative  tliroiiprl mt  tlie  experiment. 
Animal  found  dead  on  tlie  eiirluii  day.     Xo  cause  found. 

i;.\niiiT   3. — WeiL'lit  2.25tr  <;in.     Weiijlit  of  removed   kidney   fi   fim.    (approx. ). 
Weifiiit  of  reiiiuiiiiiif,'  kidney  at  deatii  S  pm. 

Sulplioneplitlialein  excretion  first       day  after  operation     '.1   per  cent. 
Siilpliono[dillialein  excretinn  second  day  after  ujieration  i!4  per  cent. 
Sulphoneidithalein  excretion  tldrd     day  after  operation  ;>.'>  I'er 
Sulplioneplitlialein  exerction  sixth     ilay  after  ojier.ition  (12  |»'r 
Sulplioneiditlialein  excretion  ei;:litli  day  after  opeiati.in.  SI'  per 
Lactose  excretion  first  day  aft'-r  operation  8  lioins-r. 
Lactose  excretion  sixtli  day  after  operation  li  liours. 
Lactose  excretion  tliirteentli  day  after  operation  5  Uoiirs. 
lodid  excretion  first    day  after  operation  30  liour;. 
lodid  excretion  sixtli  day  nft.T  (rperation  34  hour-. 
Salt  excretion  third     day  after  operation  .72  per  cent.    (1.3.5  pm.) 
Salt  excretion  ei).'litli  day  after  operation  .50  per  cent.    (1.41)  pm.) 
Alhumin  present  for  three  days.     Sediment  sliowed  rare  liyaline  casts  on  the 
thirteentli  day.     Hematuria  for  three  days.     The  animal  was  killed  on  the  four- 
teenth day. 

II.  Animal-f  with  one  kidney  removed.  Keiial  eirculati -u  elaniped  for  twenty 
minutes. 

r..\liliIT  1.— Wepjiit  l.siit)  '^ni.  Weight  of  leiiuived  kidney  CXi  iini.  Weight 
of  reiiiaininu'  kidney  at  death  5.5  L'ln. 

Siilphonephtlialein  excretion  lirst  day  after  operation  32  i  er  cut. 
Sulplioneplitlialein  excretion  tliiri!  day  after  opernti'ii  43  per  ct-nt. 

Sul|rlioneplithali  in  excretion  fifth  day  after  op>'ration  42  per  cent. 

Sulphonephthal.'in  excietion   tliirteentli   day  after  operation   4S   p'T   c.mt. 

Si  Iphoneplitlialiin   excretion  twentieth    day  after  operation   37   per   cent. 

La  tose  excreti.jn  first  day  after  operation  7'j  hours. 

Lactose  excretion  fifth  day  after  operation  0  hours. 

Lactose  excretion  fourteenth  day  after  operation  5  liour-. 

Lactose  excretion  twentieth  day  aftc-r  operation  7  hours  +. 

lodid  excretion  lirst  day  afti-r  operation  24  hours. 

lo.lid  excretiim  fourteenth  day  after  operation  24  hours. 

lodid  excretion  twentietli    day   after  operation   24    hours. 

Salt  excretion  third  (kiy  after  operatinu  l.Hd  per  cent.   (1.1  pni.) 

Salt  excretion  seventh"  day  after  ojieration     .f*     per  cent.    12.0(1  cm.) 

Salt  "xcretion  sixteentli  day  after  operation  .7  per  cent.  ( 1.0  (jui.) 

Alhumin  lires<'nt  for  seven  days.  l-"ew  hyaline  casts  found  until  the  seventli 
day.  Hematuria  for  live  days.  Animal  found  ileail  on  tlie  twenty-seventh  day. 
lli-tolo(.'ically  tlie  kidney  not  remarkalde. 

H.vniilT  2. — Weiplit  1,720  pin.  Weiplit  of  nnioved  kidney  t),4  pm.  Weight 
of  remaiiiini;  kidney  ut  death  li.5  uni. 

Sulphonephtlmlein  excretion  first  il;iy  after  opeiatlon  27  [ler  cent. 

Sulplioneplitlialein  exerel  ion  fifth  day  after  opeiation  32  l>er  cent. 

Siilplione|ditlialien  excretion  sixth  day  after  operation  (!0  per  e.-nt. 

Sulphoiiephthnlien  excretion  foiii teer.t'h  d.iy  after  opiTution  5s  i.er  cent. 

Sulplioneplithnlien  excretion  twentieth  day  after  opetntion  SS  per  cent. 

Sulplioneplitlialein  exeielion  twenty-eiplith  day  after  operation  lit  |ier  (etit. 

Lactose  i  xcretion  first  day  afli'r  deatli  7'j  hours. 

Lactose  excretion  lii'tli  day  after  o|ieration  7  hours. 

Lactone  excretion  foiirteei'itli  ilay  after  operation  5  hours. 

Lactow  excretion  twenty  ei>;hth  day  after  operntion  3  hoiir». 

loilid  excretion  first  day  after  op>'ralion  24  hoiirii. 

lodid  excretion  fifth  ilay  nfter  <]ii  ration  3')  hour*. 

loilid   excretion  foiirteeiith  day  alter  o|ie-ation  24  lioiiis. 

lodid  excretion  twenty-eiphlli  day  after  <iperation  24   hours. 

Salt  excretion  third  day  after  oiK'nition  .0  per  cent.    (1.1  B""  )• 

Salt  excretion  seventli  day  after  oiiernfion  1.2  per  cent.   (l.S  (jni.). 


1 


9 


I 


Salt  I'xcit'tion  sixtpi^ntli  il.iy  after  operation  .53  ppr  c<'iit.  (1.3  sm.). 
fialt  excretion  twenty-eisht'li  day  after  operation  Ai)  per  cnt.   i-2.00  ^:u.) . 
Albumin  present  for  tlirec  days.     Heniaturia  for  four  Jay*.     No  c.i?t-  foiimi 
after  tlie  tiftli  day.    Animal  killed  the  twenty-eighth  day. 

H.\I!BIT  3. — Weight  '2.0:20  frni.     Weight  of  removed  kidney  0.5  gni.     Weigiit  of 
ri^'niaining  kidney  at  d-atli  7.00  gm. 

Sulphonephthalein  exeretion    tir«t    day   after   operation   5.')   per   cent. 
Sul|ihonephtlialein  excretion  tliird  day  after  operation  35  per  cent. 
^:;lll[lhonellhtllalein  excretion  liftli  day  after  operation  ii5  per  cent. 
Sill]  honeiilitlialein  ex.T.  tion  lilto'iitli    day    alter    ..|i,Mation    i)4    ]'■■-   (-nl. 
Sulphonephthalein  .'xeretiun  twenty-eighth  day  after  operation  TO  per  cent. 

Lactone  excretion  first  day  after  operation  7',j  hours. 

Lacto.se  excretion  tifth  day  after  operation  4  houra. 

Lactose  excretion  lifteentli  day  after  o)ieration  4  iiour-. 

Lactose  excreiion  twenty  Jiird  day  after  operation  0  iiours, 

lodid  excretion  tr -t  day  after  operation  24  hours. 

lodid  excretion  tiftli  day  after  operation  24  h.nirs. 

loilid  excretion  twenty-third  day  after  operation  24  hour-. 

Salt  exerition  third  day  after  op.'ration   1.00  [ler  cent.    (1.1   '.'ui  i . 

Salt  excretion  twelfth  day  after  operation  .S  per  cent.    (2.4  gm.i. 

Alhurain  present  for  three  days.     Hematuria  for  one  day.    Xi>  casts  found  after 
the  sixth  day.     Animal  killed  the  twenty-eighth  day. 

Don   1.— Weight  5  kilns.     Weight  of  the  removed  kidney  20  gm. 

Sulphonephthalein  excretion  lirst  day  after  operation  40  per  cent. 

SulphoniM'hthahin  excretion  second  day  after  oi)eration  00  per  cenc. 

Sniphoiie'phthalein  excretion  fifth  day  after  operation  50  per  cent. 

Suiplionephtiialein  excretion  ninth  day  after  operation  (is  pei   cent. 

Sulphonephthalein  excretion  twelfth  ilay  after  operation  00  p.'r  cent. 

Lactcjc  excretion  first  day  after  operation  S  hours  -^. 

J.actoie  excreti(m  fifth  day  after  operation  S  hour-. 

Laet<ise  excretion  ninth  day  after  ojieration  5  leairs. 

lodid  excretion  second  day   aft.'r  opeiation  4H  lunir-. 

lodid  excretion  twelfth  day  aft.'r  operation  4S  Iumms. 

Salt  excretion  second  day  after  operation  .S5  per  cvr.t.   (3.0O  gm.). 

Alliniuin   present   for   one   day.     No  easts   found   after  the  second   day.     The 
aiiiiii.il  wa-  allowed  to  live,  since  he  had  mail.'  an  apparently  normal  recovery. 

111. — .\nnnal-  with  one  kidney  removed-,   renal  circulation  ci.imped  f^r  tliirty 
mituite-. 

ll.MKiiT   1.— Wei^lit   1.700  gni.     Weight   of  lene'Ved   kidney  ."   w..      (Ajiprox.) 
W.Mjht  oi  i.maiiuiig  kidney  after  dealli  (i.5  gni. 

Sulphonephthalein  excretion  first  day  after  operation  40  jier  c^uit, 

Sul|dioiU'iOifhal.dn  excretiim  seecnid  ilay  after  operation   40  per  cent. 

Sulphoneplithah'in  exerelicui  fourth  day  after  operation  00  per  cent. 

Sulphonephthalein  excr.'tim  thirteenth  day   after  operatiim  07   per  cent. 

Sulplionephthalein  excretion  twenty-eighth  dav  after  operation  72  per  cent. 

Sulphonephthalein  excretion  thirty-first  day  .ifter  <iperatiiin  M  p.'r  cent 

Lactose  excretion  fir<t  .lay  after  opeiation  O'.j  hour-. 

Lactose  oxcreti.iii  f.mrth  .lay  after  i'|ierati.in  5  h..in-. 

Lactose  excretion  thirteenth  day  after  o|.eration  5  lemr-^. 

Lactose  excri'tion  twenty-eialith  ilay  after  operation  5  leiur^. 

lodi.l  excreti.in  first  .lay  aft.T  operation  30  hours. 

lodi.i  excreti..n  fourth  .tay  after  operation  .'M  houis. 

lo.lid  excretion  thirt.'enth"  .lay  after  opieralion  24  hotir«. 

Salt  excr.'tion  thir.l  day  nft.'r  operation  1  3  p.T  ('.'lit.   (1.7  ..'in.l. 

Salt  excretion  sixth  .lay  after  op.'ration  .S  per  cent.   (1.4  gm.i. 

Salt  excreti..n  Ihirtytir'st  day  afte-  operation  .'.i  p.T  cent.   .1,4  ..'in.i. 

.Vllmii'inuria  for  four  .lays.     No  casts  f.iiin.l  aft.'r  th.'  t!.iit.v.nth  .l.ij.     Aniin.il 
kille.l  on  the  thirty-first  day. 

I{.\nBlT  2.— Weight   '2,400   gm.     Weiuht   of   r.'rnov.-.l    kiln'y   7.0   gni.      Weight 
of  remaining  ki.lney  after  .leath   11  ,T  gni. 


1" 


rint. 


fi.im 


Siilplioncphth;ili'in  pxorction  tir-t  ilny  after  ofcrati.m  ;;0  jut  cent. 
Siilphoneiilitlialfin  .■xcrction  second  day  after  ojieiation  4n  per  cent 
^^ulplioneplitlialein  excreticn  fnnrtli  day  after  operation  TO  per  cent 
Sulphonephtlialein  everetiim  fifteenth  day  after  operation   iVJ   i-t 
Lactone  excreti"n  tir^t  day  after  ojieration  7  lioiirs  +. 
Lactose  excretion   foiinli  day  after  oiiCration  5  lioin>. 
Lacto-e  excretion  tiftecntli  dav  after  operation  o  hour-. 
lodi<l  excretion   tifteeiitli  ilay  after  operation  24  liours. 
Salt  excrdion  tir-t  dav  after  i^peration  .7  per  cent.   (1.0  pm.). 
;«alt  excretion  tiftecntli  day  after  operation  .0  per  cent.  2.4  frni.). 
Alhumin  present  for  one  day,    llematiivia  for  two  days.    Xo  cast 
the  fourtli  day.     Animal  killed  the  fifteenth  day. 

K.Mir.iT  ?,  — Weipht  2.C00  pni.     Weifrlit  of  removed  ki-iney  (i.ti  iiv. 
reniaininf;  isiiln>'y  after  death  8  cm. 

Sulphoneplitlialein  excretion  second  day  after  ojieration  55  per  cent. 
Siilphonephtlialein  excretion  fmirtli  day  after  oi'eration  70  per  cent. 
Sulplionephthalein  excretion  tiftecntli  day  after  oj.eration  ^0  per  cent. 
Sulph'-nephtlialein  excretion  twentieth  day  after  ulceration  74  per  cent. 
Lactose  excretiim  first  day  after  operation  7  hours. 
Lactose  excretion  fonrth  day  after  operation  5  hour-. 
Lactose  excretion  fourteenth  day  after  operation  7  liinirs. 
Lactose  excretion  twentieth  day  after  O|ieration  5  honrs. 
lodid  excretion  first  day  .after  operation  24  hiinr-. 
lodiil  excriticai  fourth  ilay  after  operation  24  honi-. 
lodid  excretion  tiftecntli  day  after  operation  24  hours. 
Salt  excretion  third  day  after  operation  1.1  per  cent.   (2..'i  jrm.K 
Salt  excretion  fonrteenth  day  after  operation  .52  per  cent.    (2.1  <:"i)- 
Salt  excretion  twentieth  day  after  operation  .fio  per  cent,   (l.n  j.-ni.). 
Alliiimin  present  for  one  day.     Ilemattiria   for  one  day.     No  casts  see 
the  third  .hiy.     Animal  killed  tlie  thirtieth  day. 

U,„;   l.—Wi.i-ht  7  kilos.     WeiLdit  of  reniovd  kidney  24  'jm. 
Siilphonephtlialein  excretion  secoml  day  after  opera! iim  .'Ui  per  cent. 
Sulphonephtlialein  excretion  third  day  aft.r  ojieration  52  per  cent. 
Sniidionephthalein  exention  fifth  day  aft.r  operation  55  per  cent. 
Laeto-e  excretion  thinl  day  after  operation  S  hours. 
Iodic!  excretion  -■eond  day  after  operation  4S  hours. 
Salt  excretion  third  day  after  operation  1  per  cent,  i  l.i'.  !.'ni.i. 
Alhiimin   for   two   days,      ta-ts   fotind   on    the    liftli    day.      .\nimal 
uneventful  recovery  ami  allowed  to  live. 

IV.— Animal   witli   one   kidney   removed;    lenal   eireu'ation   clampe.l   fi 
niiniites. 

l!.\Hi;ir   1. — \Vei<:lit  2.070  |:ni.     Widpht  <if  removed  kidney  5.7  -im.     W 
remainin'.'  kidney  after  death  7.2  '.'in. 

Sulplionephthalein  excretion  lir-t  day  after  opeialiin  24  per  cmt. 
Siilpl.one]dit!ialein  excretion  -econd  day  after  operation  40  iii'r  cent. 
Sn'plioniphtli.ilein  excretion  third  day' after  oju'ration  50  per  cent. 
siilphone]dit!ialein  I'xeretion  fourth  day  after  operation  Ii2  per  cent. 
Siilphonephtlialein  excretion  ciLdith  day  after  op'Tation  70  per  cent. 
Lactose  excretion  secoml  day  after  ojieration  (1  iKUirs. 
Lacto-e  excretion  eiiihtli  day  after  operation  <i  hours. 
LaetoBe  excretion  twelfth  day  after  ojieration  5  hours, 
lodid   excretion   first   day   after   operation   4S   hour-. 
Salt  e.xcretion  fourth  day  after  operation   1  per  cent.   (15  pni.). 
Salt  excretion  tenth  day' after  operation  .7  per  cent.   (1.2  jiin.i. 
Alliuminurin  for  eiyht   days.     Hematuria   for  one  day.     No  casts  f,,ii 
tlie  fourlli  day.     Animal  killed  on  tli..  twelfth  <lav  on  ae.-ouiit  of  ^'l  i 
I'lAnniT  2. — Wei'.'ht  1.000  (.'ni.     \Veit;ht  of  removed   kidney  4,0  - 
renininini:  kidney  after  death  0,5  jjm. 

Sulplionephthalein  excretion  first       day  after  operation  40  p.  r 
Siilphonephtlialein  exention  second  day  after  operation  47   per 


il  after 

JL'llt    of 


n   aft.'r 


ladi    an 

ir  forty 

ij^ht  of 


.il  i 


id   after 

nfeccion. 

itdit  if 


• 


1 


Siil|.lioiKi.hth,-.lein  woretinn  tliir.!     day   aft.r  oiioration  oU  lior  cut. 
Laotose   excrcti.ui   tir-t       day   after   opnati-n     8   liours  -r- 
Lactose   excretion   tlur.l     .lav   after   ciporation      7   Iioiirs  +. 
lodid       excndion    fir^t        day   after   oiicration   3(1   Iiours. 
lodid        excritiiin   tliird     day   after  operation   24   li-.urs. 
Salt  excretion  third  dav  after  operation  1  r*"'"  cent.  ( I.',  pm.) 
AUiumin  an.l  casts  present  u.-.til  deatli.     Animal  killed  on  the  fourth  day  on 
account  ci  general  infection. 

i;.\nmT  3.— Weight   2.200  gm.     Weight  of  removed  kidney  tl.nu  gm.     Weight 
of  reniainini;  kidnev  aftvr  deatli  ll.OH  gm. 

Sulplioneplitha'ein  excretion  first  day  after  operation  45  per  cent. 

Sul phonephthalein  excretion  second  day  after  operation  54  per  cent. 

:>ul  dioneldithalein  excretion  fourth  day  after  operation  1,0  per  cent. 

.-nlphoneidithalein  excretion  fifth  day  after  operation  70  per  cent. 

Lactose  excretion  first  day  after  operation  S  hours. 

Lactose  excretion  tliird  day  nfter  operation  5  Ikuivs. 

Lactose  excretion  llfth  ('ay  alter  operation  4  Innirs. 

lodid  excretion  lirst  day  after  operation  30  hours. 

lodid  excretion  third  day  after  operation 


(1.00  gm.) 

.) 
d.iv.     No  casts 


14  hours. 
Sait'exereti'on"seeond  daV  after  o'pe.„tion  M  per  cent.   (1.00  gr 
Salt  excretion  fifth  day  after  operation  .1'  per  cent.   r..5  gm.) 
Albumin  present  for  three  days.     Hematuria  for  one 
.  fourth  day.     Animal  killed  on  the  sixtli  day. 
KAninr  4.— Weight   1.77U  gm.     Weight  of  leiiieved   kidney  r,.m  gm 
remaining  kiiinev  after  death  7.00  gm. 

Snlrd.onephthalein  excretion  first  day  after  rieration  15  per  cent, 
Sulphonephthalein  excretion  second  day  after  operation  14  per  cent. 


een  after 
Wei-'.it 


Sulphonephthalein  excretion  third  day  nfter  operation  S  per  cent. 
Lactose  excretion  tirst  day  nfter  operation  S  hours  +. 
Lactose  excretion  third  day  after  operation  0  hours. 
lodid  excretion  lirst  day  aft.r  upeiation  30  ,Hr  cent. 
Salt  excretion  second  dav  after  operation  1.00     per  cent.    (..   gm.) 
No  allmmin  f.mnd  after'the  sec-nd  day.     Hematuria  f-r  one  .lay.     Ca-ts  swn 
on  'the  thir.l  dav.     Animal  found  dead,  on  tlie  fourth  .lay  with  acute  peritonitis. 

of   remoVMl   khlney   7   gm.      Wri-!it   of 


l!.\niiiT  r>,— W.ight   2.3JO  gm.     W  ,  igli 
remaining  knlney  ait.T  d.'aih   10  gm. 


Suhdemeiilithalein  excreti.m  tirst  .lay  after  oper.'.to.n  4,    p.r  cent, 
^iilph.nieidithalein  excretion  fourth  day  after  operation  CJ  per  cent. 
Sul  d...n.pl.thal.'in  .xcr.tion  tu.dfth  day  after  operation  1)7  per  cent. 
Sul  .honeihthalem  exir.tion  f.mrt.enth  .lay  nfter  ..pcvation  .0  per  cent 


.) 


Laeto-e  excn'tion  secon.l  .lay  after  operation  0  li.aiis. 

Lactos,.  excretion  fourth  <lay  after  operation  (i  hours. 

Lactose  excretion  thirtc.ntli  day  after  operation  5  lean-. 

lodid  excretion  second  day  after  operathm  24  hour-. 

Salt  excretion  second  .lav  after  ..peration  .7  per  cent.  (  l.i  gni.)_ 

Salt  excretion  thirteenth  .lav  after  operation  .0  per  cent,    [-..o  i:: 

Allaiminuria   f.T  t«o  .lays,     (asfs  pr,.sent   for  four  .lays.      Animal   k.lhd  on 

t!  e  litt.rnth  ilav.  „.  .    ,  , 

1„„;    l,_Weiglit    0    kih>s.      Weight    of    reuiove.l    kidn.'y    33    gm.      Weight    .,1 

reniaininL'  ki.lney  after  .hath  SO  gm. 

Sulphon.lditlialcin  excretion  first  .'ay  aft.T  .'p.'ratmn  trac.s. 

sulphon.M.hlhahiu  excretion  second  .lay  after  open.tion  traces. 

Suliihonephthalein  exer.tion  third  day  after  operation  traces. 

I  act'^e  excretion  first  .lav  after  opernti.m  S  h.uirs  +. 

Laclo-o  .'xcretion  s.c.mil  day  after  operation  S  hours. 

Salt    and    iodhl    not   given.      Alliumin.    Id.ind   and    ea-|s   pre-ent    until    .leath. 

Animal  kill.d  on  the  fourth  day  on  account  of  rxtf tox.niia. 

:  — WeiL'ht  10  kilos.     WeiL'ht  of  remove.l  kidney  30  gm. 

litluilein  exereti.>n  first  day  after  operation  20  per  .'ent. 


D.ii. 

Sul|il 


-n.pl 


sulpla 


.  o!t  iMl.-in 


Mti.'ii  lliir.l  .lay   aft.-    .p.  rati. ill  30  piT  cut. 


1-2 


Siilplionoplitlialoin  excretion  fourth  einy  after  o|ifiation  ()4  pi'r  cent. 
Nullilioiu'plitluilfin  cxeri'tion  sevuntli  day  after  op,-ration  liS  jjor  ceut. 
Lactose  excretion  lirst  ilay  alte;-  operation  S  hours  +. 
Lactose  excretion  fuurtli  day  after  operation  S  liours  +. 
Lactose  excretion   seventli  day   iifter  operation  0   liours. 
lodiil  excretion  second  day  after  operation  48  hours. 
Salt  excretion  second  day  alter  operation  .4  per  cent.   (.SO  i;ni.) 
Alhuniin  present  for  four  days.     Xo  casts  seen  after  the  fourth  day. 
made  an  imeveiilful  recovery  and  alloweil  to  live. 


Aiiiiual 


\. — .\iiinial-    \vitl[    one    kidne 
hour. 

KAiiiiir   I. — WeiL'lit   l.ToO  ijni.     Wi 
reiiiamini:  kiiiney  after  death  7.5  !;ir.. 

Suli>hiineplithalein  excretion  first  day  after  operation  '32  per  cent. 


removed:     renal    circulation 
.dit  of  removed  kidnev  7 


-d   for   on-' 


Wei.'ht  of 


-nt. 


dav 


kidney  after  death   il.'M)  gm 


Animal   died   amnio   in   s 
ht  of  n-moved  kidie.'v 


Animal 
Wei-iit  of 


Wei-ht 
ntv-two 


m.      Weight   of 


Sulphonephthalein  excretion  third  day  after  operation  .3.')  \ 
Larto-e  e\eretinn  second   day  alter  oj.eration  S  liours  +. 
lodid  excretion  second  day  after  operati<n   2  liours +. 
Salt  excretion  second  day  after  operation  .(i  per  cent.   (.5  trm.) 
Alhuniin  anil  casts  found  on  the  third  day.     Hematuria  for  on 

found  dead  on  the  fourth  day.     Autopsy  showed  acute  peritonitis. 
i;.\nniT  2.— Wcisht  i.lKJil  L'tn.     \Vei;:lit  of  removed  kivliiey  5.2  ■jm 

remaininu'  kidney  after  death  C.5  pm. 

Sulphonephthalein  excretion  first  day  after  opi'ration  7  [ler  cent. 

Lacto>e  excietion  second  day  after  operation  8  hours  4-. 

Salt  excretion  sicoiiil  liay  alter  I'peration  .7  jier  cent.   (.>*  ^in.) 

.\lhumin.  ea-t-  aii.I  lilood  in  the  urine  on  the  t];ird  day.     Animal  found  dead 

i:.\nmr  3. — Weiudit   I.mm.7  urn.     \Vei;:ht  of  removed  kidney  il.i)0 

of  remainin 

hours. 

I'iAniilT  4.— Weiirht   1.7<iO  frni. 
remaining'  kidmy  after  death  lt.5  ;_'ni. 

Sulplione|ditlialeiii  excretion  first  ilay  after  operation  !'  per  e.Mit. 

Sulphonephthalein  excretion  second   day  after  operation    12  per  cent 

Sulphonephthalein  excretion  thir.l  day  after  operation  20  per  cent. 

Sulphonephthalein  excretion  sixth  day  after  ojination  8  jier  cent. 

l^aetose  excretion  first  day  after  operation  H  hours +. 

Lactose  excretion   third  day   after  operation   S   hours  -f-. 

lodid  excretion  first  day  after  operation  48  hours. 

Salt  excretion  third  day  after  ojieration  .8  jier  cent.    (2  I   ;.'m.l 

.Mhumin  and  casts  present  until  death.     Animal  found  d.a.l  a  f 
last  note.     I'hthalein  excreted  in  traces,  lactose  markedly  dtdayed. 

H.vi-BIT  5.— \Vei;;ht   L400  j-m.     Wei-ht  of  reni.,\(.d   kidney   4   ltii 
remainin:;  kidney  after  death  !i.5  o'"- 

Sulphonephthalein  excretion  first  day  after  op.ration   trace-. 

Sulphonephthalein  excretion  second  day  after  operation  traces. 

Suljihonephtlialein  excretion  third  dayafter  operation  traces. 

Lactose  excretiou  first  day  after  operation  none  recovered. 

Alhuniin.  hloo.I  and  casts  present  until  death  on  the  fourth  day 
last  twenty-four  hours  pu.ssed  10  c,c.  of  urine. 

\'L — Animals  in  which  the  renal  circulation  has  l«-en  chimi 
(or  an  hour,  the  other  kidney  bein;;  left  untouched. 

llAniilT   ].— Weight   LlioO  :.on.     W.d^dit  of  unehimped  kidney  at  death  o.oO  ;.'m 
Weijjht  <if  clamped  kidney  at  death  5.0(1  ■;m. 

Sul]di"nephthalein  excietion  first  day  after  op.eration  SO  per  cent. 

Sulphonephthalein  excretion  second  day  nfter  operation  52  per  cent. 

Sulphoiiephthah-in  excretion  sixth  liay  after  operation  5(1  per  cent. 

Siilphtiiiephthalein  excretion  eij;hth  ilay  after  oper;ition  75  p"r  cent. 

Siilphonephllialein  excretion  eiL'hteenth  ihiy  after  opeiation  00   per  cent. 


■d   in 


days  after 

U.  i-hl    of 


During'  the 
one  kidnev 


• 


• 


13 

Siilphcnophtlialpin  oxcrftion  twenfy-sfcond  day  after  operation  70  per  cent. 

Siilpliornplitlialein  (xcretion  twentytiftli  day  after  operation  7l)  per  cent. 

Lactose  excretion  first  day  after  operation  7  lunirs. 

Lacto^e  excretion  fourth  day  after  operation  0  hours. 

Lactose  excretion  eighth  day  after  operation  5  hoiir^^. 

J-iictOr^e  excretion  lifteentli   day  after  ojieration  ll  hour.;. 

Lactose  excretion  twenty-tifth  day  after  operation  5  lumrs. 

lodid  excretion  first  day  after  operation  24  lionrs. 

lodid  excretion  <'if.'litli  day  aftir  operation  24  lionrs. 

lodid  excretion  twenty-second  ihiy  after  oj)eration  24  lionrp. 

Salt  excretion  sixtli  day  after  oi}eration  .5  per  cent.   (Ll  pni.). 

Salt  excretion  twenty-tiftli  day  after  operation  .70  per  cent.    (1.2  <:ni.) 

Albumin  present  for  two  days.  No  casts  found  after  tlie  sixth  day.  .\niinal 
killed  on  the  twenty-sixth  day. 

Kabbit  2. — \\eii;!it  2.200  fini.  Weiglit  of  nnclaniped  kidney  at  death  7.5  gm. 
(approx.).     Weight  of  clamped  kidney  at  (hatli  7.5  gin. 

Sulphonephthaliin  excretion  first  day  after  operation  5!'  jier  cent. 

Stilphonephthalein  excretion  fifth  day  after  operation  74  per  cent. 

Siilphonephthalein  excretion  seventeenth  day  after  operation  7S  per  cert. 

Lactose  excretion  tliinl  day  after  (jperation  i!  hours. 

Lactose  excretion  tenth  day  after  operation  7  hours  4-- 

Lactose  excretion  (iglite«>nth  day  after  operation  ti  hours. 

lodid  excretion  thiril  day  after  operation  24  hours. 

lodiU  excretion  eighteentli  day  after  operation  24  Iiotirs. 

Salt  excretion  eighteenth  day  after  operation  .3  per  cent.   ( 1.20  nni.l 

Albumin  present  for  one  day.  Xo  ca^ts  seen  after  tlie  fifth  I'ay.  .\ninial 
killed  on  the  nineteenth  day. 

R.^nRIT  3.— Weiglit  1.700  gni. 

.'^ulplionejdithnlein  excretion  tirst  day  after  operation  50  per  cent. 

Sulplioneidithalein  excretion  thiril  day  after  ojieratii'n  5S  per  cent. 

Siilphonephthalein  excretion  seventh  day  after  [operation  70  per  c(nt. 

Lactoso  excretion  tliiid  day  after  operation  ti  hours. 

Lactose  excretion  sevinth  day  after  operation  5  hours. 

luiiid  excretion  tir-t  day  after  operation  24  hours. 

lodid  excretion  -eventh  day  after  oiieration  24  hours. 

Salt  excretion  fifth  day  after  operation  .7  per  cent.    (1.4  gni.) 

Albumin  pre-ent  for  one  day.  Casts  found  on  the  seventh  day.  .\niinal  found 
dead  on  the  twelfth  day.     No  cause  found. 

\1I. — Animals  in  which  one  kidney  has  been  renioved,  the  circulation  of  tiie 
other  being  left  untouched. 

K.xnniT  1. — Weight  l.flOiT  gni.  Weight  of  removed  kidney  7  gm.  Weight  of 
remaining  kidney  after  death  7.5  gm. 

Sulplionephthalein  excretion  tirst  day  after  operation  50  per  cent. 

Sulphonefdithalein  excretion  second  <lay  after  oi'eratioii  ('..")  per  cent. 

.^ulphom'idithah  in  excretion   fifth  day  after  operation  (10  per  cent. 

Siilphonephthalein  excretion  ninth  day  after  operation  70  jier  cent. 

Lactose  excretion  first  day  after  ojieration  5  hours. 

Lactose  excretion  ninth  day  after  operation  5  hours. 

Lactose  excretion   sixteenth   day  after  operation  0   hours. 

lodiil  I'Xcretinn  tir-^t  day  after  operation  24  hours. 

lodid  excretion  sixteenth  day  after  operation  24  hour*. 

Salt  excretion  third  day  after  operation  .5  jier  cent.   I  2.00  gni.) 

Traces  of  alhiimin  found  for  one  day.  lilood  and  easts  found  for  one  day. 
.Animal  killed  on  the  twentieth  day. 

KAiiniT  2. — Weight  2.200  pm.  Weight  of  removed  kidney  (1  gm.  Weight  of 
remaining  kidney  after  death  S.5  L'ni. 

.^iilplionephthnlein  excretion  first  day  after  o|'rration  iKl  ]ier  cent. 

Siil|dioneplitlialein  excretion  second  day   after  opi  ration   70   pi-r  diit. 

Siilphi'neplthalein  excretion  twilfth  day  afti-r  operation  75  per  cent. 

Siilphoin'[.litlialein  excretion  tliirl"entli  day  after  opirntion  SO  per  cent. 


14 


liieto^e  oxrretion  fir^t  d;.y  iift.-r  oprnition  •'>  1'""'^ 

a    OS.'  ox,.ret,..n  tlnrtoen.h  ,h,y  .ft.r  "l-"'"'"  -  "-"- 
locli.l  excretion  tir.t  cloy  aft.  r  op'^roti'in  -^''""["- ,  ,„^ . 
In,    ,    excretion  tl.irteontl,  day  after  operation  24    •"»•_-. 
k.li  excretion  third  dav  after  ^l^-^- .;^.J:-.-"  J  ;;r  !  1.,   ..-..) 
salt  excr.t,on  »■•-'-';;>   "^^;^;-:l,     .x„nnal  ki'lod  ...  th.  fonrt 
Albumin  present  for  one  day.     >o  ca  i»    e.  n 


day 


ntli 
-ni.     \V,i-!it  of 


llAimiT  3-\Veipht  l.S5()  ?m.     Weifzht  of  removed   kidney 
remaining'  kiilney  after  death  7  pu. 

Snlphonophtllalein  excretion  .ir.t  dav  f-;;';"  ^i;     -\     'p;     int. 

lactone  excretion  first  day  after  operation  ^^  '"""^i- .    ,„., 
cto4  excretion  ninet^^nth  day  after  operation  o  liou,,. 
Indid  excretion  first  day  after  operation  24  '■"•>,'^^. 
"Il'id  Excretion  nineteenth  day  -^'"  'l^f^^^^J:^'''- 
Salt  excretion  tliir.l  day  a  ter  ''';'''''>''  "  j ', '    Vl  ,  er  cent.   (1..1  '-niO 
Salt  excretion  nineteenth  day  after  operation  1.1  per  '""'\  , 

AUmniin  present  for  one  day.    Hematuria  for  one  day.     Animal  kilhd        t... 
twentytirst  ilay. 

c'h.npiit.  of  the  renal  eireulatimt  up  to  foriy  minute,  in  the  n.ajoritv 
of  «.'  s,  pmiluced  a  definite  ai.tuvban.e  in  renal  function.    Its  tnten^ty 
Jo'no  ilation  to  the  len.th  of  time  the  vessels  were  danM^d.  n  >      - 
the  va^cular  or  tubular  funetiou  chiefly  affeetod   (Protocol.  I  to  U). 
ni^4.>.n  bv  the  presence  of  albumin  and  east,  m  the  urine.  1^  a 
•::;ed     h:;talein  otitput  of  varyin.  do.ree   and  bv  a  delayed    ae^e 
and  u.lid  excretion.     Salt  was  constantly  well  excreted.     The  an  m  ^ 
reecverin,,  renamed  nearly  normal  f.nutioft  withtn  six  l^^'^'-  ;   -''  " 
hat  the  disturbance  was  slight  and  temporary.     One  antmal  fa.    do 
^i^rn  to  a  normal  phthaleuf  otitput.    So  explanation  wa.    ouml 
at  autopsv.     Two  animals  with  circulation  clamped  for  fo,t>    m.n.te. 
died  quickly  with  marked  si?ns  of  renal  insttffictency.  .     ^-^.^.^^y^. 

All  the  animals,  however,  with  one  kidney  ^^^^'''^''^'^'\'^, 
tion  of  the  remaining  kidney  clamped  f"". -;/""l^U  v  •^'  1.1 '^  te 
^vithin  ei.ht  davs.  Thee  was  evidence  dinically  as  well  -  >  ^^  ^^  ; 
of  extrem'e  distuioance  of  function.  An  interesting  P--  "J.'-.^  J^^ 
tant  a  part  in  renal  sur,e.-y  the  unoperated  k.dney  ph>s  '^  '  '  ^ 
...onJvi.  In  tl...  ser,es.  thou.h  the  circlation  "-  ^'-"H  ^^ 
hour,  with  a  norn.al  kidney  r.ma.nin,.  the  function  was  but  >l,...th  and 
tcmporarilv  disturbed.  ,.,-.„u- 

That  the  ciT.vt  of  nophre-tomy  alone  did  no  p.^oduco  he  .cm.Is 
obtained  ,s  seen  fron.  P.-otoco,  VII.  In  two  at.ima  s  the  -^  -;^  ^^^ 
„.,ve  unafTected.  In  the  .bird  the  phthalom  output  was  .-Ic.'hth  ,.du,ed 
for  Hire.  davs.     Tb,.  other  tests  we.'e  normal. 

l.„i,„l„„c:,llv.   similar   changes   were  .loted   to   tho.e   de-..,h    1    o 
nivM.nis  authors;    The  earliest  -han^es.  -x.-osslv,  wee  ma.kod  ron^.stinn 
;         lucvd    n„n..te  be,ma,ha.es.     As  the   len.th   of   .nn.   fodow.,.g 


• 


15 

,  „l     tl,f.    kidprv-    liv.R-rtroi.hioa,    but    otherwise 
the    opcriUiun    inrr  a^'U,    tlie    kuii.tv     ".  i  i 

appeared  normal.  .lo^tviii-tioii  of 

^^Lcrccopieally  first  were  seen  hemorrhage,  f^'/^-^^l^, 

siderablc  length  of  time  without  harm. 

CON'CLrsiONS 

1     In  r.bbit^  and  do.,  with  one  k.dnev  removed.  tl,e  circulation  of 
J:^:SL'...y  be  .lamped  for  a.  ^n.  a  t..  a.    o^  ..n-^ 
with  recovery.    If  the  renal  circulation  is  clamped  for  a  Icn.er 
animals  die  with  sicrns  of  renal  insulTioency.  ^^^^^_ 

o    In  animals  with  the  circulation  clamped  foi  not  ^""-'^;'':"  ^    ^ 

„„;;.^  ...,.,o,„v  ,,..,„,„»™  u. "»' ^;»;::  ■:;  ■;  T'^in;":" 

bv  the  presence  of  albumin   and   casts  in  the  u-Ul.  n, 

phti!;i,u  output  and  bv  a  delayed  lactone  and  iod.d  excrefon.    Normal 

function  is  regained  witliin  si.x  days. 

3     .\cute  or   healed  pathological   changes  are   tound   m  ki  ^^ 

tissue      ^o  ]no'rix'^<i^-e  \csionis  i^v.nd.  ,,i.„;,,u 

r  E.ce,i  u;  the  most  extreme  ca^es.  there  >s  no  '^'^^"'^  ^^^^  ; 
demonstrable  bv  the  functional  tests  u..l  between  tne  patholo.Kal  a.u. 

^""f  r^r!S;;:':;rrt;:!al  kumey.  t,.  .rcmation  of  th.  o^^r 
kid:;y^m::tdamped  for  at  lea.  an  hour  without  permanent  u.ur> 
to  the  animal's  general  condition  or  renal  function. 


